Breakfast in cemetery
Boy tastin’ wild berry
Touch girl, apple blossom
Just a boy playin’ possum
We'll come back for Indian Summer
We'll come back for Indian Summer
We'll come back for Indian Summer
And go our separate ways
What is that cheerful sound?
Rain fallin’ on the ground
We'll wear a jolly crown
Buckle up, we're homeward bound
It’s been almost two weeks since the last Ebola patient was
discharged in Liberia. It’s been over a month since my mom left us. It’s been
more than three months since I saw Jess and the girls. The rainy season is
almost here. Time to go home.
Those of you who know me well know I’ve been a fan of REM
since the first four drum notes that start Radio Free Europe came over the
airways on WBCN in Boston. Amazingly, I had never heard the song Indian Summer
until just recently. To me the first stanza speaks to freedom, the seasons, birth,
rebirth, life, promise, growing up, new experiences and perhaps a bit more. The
last few months have certainly been full of all those thoughts…and more. I’ve
never met Michael Stipe the REM songwriter. From what I’ve read he would
probably think my interpretation crap.
Oh well. Some final thoughts follow.
The nasty filovirus that
is Ebola (filo means thread in Latin and the virus looks like a bent piece of
thread under the electron microscope) has killed more than 4,200 in Liberia. I
was here in September and October when there were literally bodies in the
streets, everyone wore a perpetual mask of fear and doom. No one knew what lay
ahead. I came back in December and saw a different country, a different people
and a different mask. People had hope. People felt it could be defeated. Three and
a half months later it looks like we’re there. Still, there’s bound to be a
case or two here and there. The reality is the disease may be endemic and
resident in the human population now meaning it is always around, in someone,
somewhere. Previously the disease was zoonotic meaning its host was something
in the animal kingdom. Most researchers now believe the host (the animal that
carries the virus but does not get sick from it) is the fruit bat. There are
many theories as to how the virus jumps from the fruit bat to people. In some
cases the virus may be in bat saliva on a piece of fruit that falls to the
jungle floor and is picked up by a human. People eat bats too. Maybe that’s another
way it is transmitted. No one really knows. And of course our nonhuman primate cousins
the chimps and the gorillas are, like us, very susceptible to the virus. As many
as a third of the world’s gorillas have been killed by Ebola. In
West Africa, the recent Ebola outbreak probably began with a 2-year-old Guinean
boy who touched a droplet of bat feces in December 2013.
The word Ebola continues to strike fear in people – and for
good reason. It still kills a significant percentage of people who get it. They
die in an often gruesome way and there is no proven cure or treatment. Instead,
we go back to basics. Even in the highest of the high-tech centers where
certain Ebola patients are treated we still do little more than support the
patients vital functions and treat the symptoms. The virus causes the body to mount an intense
inflammatory reaction that can wreak all sorts of havoc in the body (like
bleeding) before it begins to help and defeat the virus. It’s kind of a race.
The winner is too often the virus. Another race exists for drugs and vaccines.
Some of the drugs like ZMapp show great promise. Even better, certain vaccine
trials hint at a future where routine prevention may be possible. Time will
tell.
Despite all the critiques and finger pointing about the
early days of the response one thing is clear and indisputable. When the world
finally did get its ass in gear the global community rocked. Things got done.
ETUs were built in the middle of nowhere seemingly overnight. Staff poured in. Thousands
of people were trained to care for victims. Whole nations changed their
behaviors. Ebola etiquette became not only a catchphrase but also a way of life.
This is a war and like all wars it is being won with logistics. The amount of
stuff that rained down on West Africa in the last several months is simply
mindboggling. There is so much stuff the continent of Africa leans a bit to the
left now the west coast groaning under the weight of PPE, medicines and other
supplies. Fortunately the world also brought expertise and enthusiasm. Combine
stuff, expertise and enthusiasm and you have a recipe for success.
Friday cannot come quickly enough. The Brussels Airlines
flight leaves at 930 at night. It takes a little over an hour to get to the
airport from our compound. In order to get through the maze and madness that is
an African airport we get there a good two and a half hours to three hours
before. Wait in line to get the car into the airport. Have your temperature
taken. Drag your bags to the screening area. Fill out the form that asks if you’ve
washed a dead body, eaten monkey meat or had bloody diarrhea recently. Wash
hands in .05% chlorine. Hand in form. Fill it out another one since the
chlorine dripped and made parts illegible. Sweat buckets because it is hot as
hell and you’re dragging luggage and packed in with dozens of people. Have your
temperature taken again. Panic. Wash hands in chlorine again. Repeat. Now
you’re in the airport.
Between now and Friday I have to follow up with all my
medical officers and see how best to begin transitioning our people, services
and stuff. I suspect that may require a few trips this week out to the sites.
When I head back to Monrovia on Thursday from wherever I will be likely be bouncing
in anticipation. I miss everything about home – my friends, my waves and of
course my family. Jessie has once again proven herself our family’s anchor and the
best thing that’s ever happened to me. How did I get so lucky? Haley and Piper
make my heart sing every time I hear their voices on the phone. To imagine
hearing them in person is almost too much. Piper, God love her, demands that I
confirm my status prior to hugging me. I’ve promised her I will take a rapid Ebola
test before I leave. We’ve used them a bunch and now they’re WHO approved. That
said, I totally understand if any of my friends think it best to maintain a
certain distance. It’s such a weird disease and so misunderstood I would never
argue. Remember though – you are not infectious unless you are symptomatic.
Fever of course is the first sign. I’ll carry a thermometer. I wouldn’t know
what to do without one. Conservatively I have had my temperature taken over a
thousand times in the last few months.
Monrovia to Brussels. Brussels to Newark. Overnight Saturday
in Newark. Anyone know any good airport hotels? Sunday morning airport
Starbucks and direct to Honolulu. I hope to have my family in my sight and the
scent of plumeria in my nose by midafternoon Sunday. Buckle up. We’re homeward
bound.
Note: The lyrics to Indian Summer are by REM
